Kawm Txog Lub Tshuab Ntawm Gujian Powder Intervention On Steroid-induced Necrosis Of Femoral Head Based On Macrophages Thiab Nws Txoj Kev

Abstract:Steroid-induced necrosis ntawm lub taub hau femoral yog ib yam kab mob uas tshwm sim hauv orthopedics, uas yog tshwm sim los ntawm glucocorticoid thiab tshwm sim los ntawm ntau yam. Nws yog ib qho nyuaj rau kho thiab muaj cov nyhuv curative tsis zoo, uas muaj kev cuam tshuam loj heev rau kev ua neej zoo ntawm cov neeg mob. Cov tshuaj suav tshuaj hauv kev kho mob steroid-induced necrosis ntawm lub taub hau femoral tsis tuaj yeem txhim kho qhovcov tsos mob ntawm tus kab mobmas also tshem tawm cov hauv paus hauv paus ntawm tus kab mob, uas hasobvious zoo. Wei Guikang, tus tswv ntawm cov tshuaj suav tshuaj suav tshuaj, suav nrog cov tshuaj ntawm Gujian Powder raws li xyoo ntawm kev kho mob, uas kho tau zoo thaum ntxov steroid-induced necrosis ntawm lub taub hau femoral. Los ntawm kev tshuaj xyuas cov ntaub ntawv thiab kev tshuaj xyuas, nws tau txiav txim siab tias tag nrho cov tshuaj suav suav thiab lawv cov khoom siv zoo hauv GujianPowder tuaj yeem koom nrog kev tswj hwm ntawm IL-6, IL-1, IL-10, TNF-, iNOS. , COX-2 thiab lwm yam tseem ceeb ntsig txog kev mob plab los ntawm kev tswj cov teeb liab txoj hauv kev ze ze rau macrophages, xws li NF-κB, Wnt/ -catenin, MAPK, COX, thiab iNOS. Txawm li cas los xij, vim hais tias cov pathogenesis ntawm steroid-induced necrosis ntawm lub taub hau femoral yog qhov nyuaj dhau los, qhov kev tshuaj xyuas no tsuas yog nthuav tawm ntawm qee cov txheej txheem, muaj ntau cov tshuaj suav tshuaj hauv Gujian Powder, thiab kev sib cuam tshuam ntawm ntau yam tshuaj suav tshuaj suav nrog cov tshuaj yog tsis meej, yog li nws tsuas yog nthuav tawm qee cov txheej txheem ntawm cov tshuaj suav tshuaj cuam tshuamSteroid-induced necrosis ntawm lub taub hau femoral, thiab covmechanism ntawm nws cov tshuaj yuav tsum tau kawm ntxiv

Ntsiab lus: Gujian hmoov; Steroid-induced necrosis ntawm lub taub hau femoral; Txoj kev teeb liab; Kev tshawb nrhiav kev vam meej

NEW HERBAL FORMULATION HIGH-QUALITY CISTANCHE RAU STEROID-INDUCED NECROSIS ntawm FEMORAL taub hau

NYEM QHOV CHAW UA HAUJ LWM

Steroid-induced necrosis ntawm lub taub hau femoral(SNOFH) yog ib hom kab mob orthopedic uas nyuaj kho. Tam sim no, qhov tshwm sim ntawm qhov tsis raug mob femoral taub hau necrosis yog siab heev hauv kuv lub tebchaws, muaj ze li ntawm 10 lab tus tib neeg raug mob los ntawm tus kab mob no. Kev siv ntau dhau ntawm cov tshuaj hormones yog ib qho ntawm cov laj thawj tseem ceeb ntawm kev mob femoral taub hau necrosis [1]. Kev siv cov tshuaj hormones ntev tuaj yeem ua rau cov ntshav tsis txaus rau lub taub hau femoral, kev puas tsuaj ntawm cov pob txha hlwb thiab cov pob txha pob txha, ua rau muaj kev hloov pauv ntawm cov pob txha, kev sib tsoo ntawm lub taub hau femoral, thiab kev sib koom ua haujlwm tsis zoo, thaum kawg ua rau muaj qhov tshwm sim ntawm cov pob txha. NCO [2]. Hauv chav kawm ntawm SNOFH, macrophages tuaj yeem cuam tshuam rau theem ntawm qhov mob thiab qhov sib npaug ntawm OB thiab OC los ntawm ntau txoj hauv kev [3]. Raws li cov chav kawm ntawm SNOFH txuas ntxiv mus, cov neeg mob yuav ntsib cov tsos mob xws li mob hauv siab thiab qis qis qis zog. Raws li tus kab mob no zuj zus, lawv tuaj yeem ntsib tag nrho lub duav hloov. Txawm li cas los xij, tag nrho lub duav hloov pauv kuj muaj ntau yam teeb meem xws li tus nqi siab, ntau yam kev tsis zoo, thiab cov neeg mob tsis zoo.

Nrog rau kev txhim kho txuas ntxiv ntawm cov tshuaj suav tshuaj, ntau yam tshuaj suav tshuaj suav ua lub luag haujlwm tseem ceeb hauv kev kho SNOFH thaum ntxov. Raws li cov tswv yim tseem ceeb ntawm cov tshuaj suav tshuaj thiab kev kuaj mob mus sij hawm ntev thiab kev paub txog kev kho mob, Wei Guikang, tus tswv ntawm cov tshuaj suav tshuaj, tau sau cov tshuaj classic thiab tsim cov tshuaj hu ua Gujiansan, uas muaj cov txiaj ntsig ntawm kev txhawb nqa lub siab thiab lub raum, tshem tawm cov ntshav stasis thiab txhawb cov ntshav tshiab, rau kev kho mob ntawm SNOFH. Tag nrho cov tshuaj ntawm Gujiansan muaj 11 Suav tshuaj ntsuab, uas txhais tau hais tias "ob tus huab tais, plaub tus thawj coj thiab tsib tus pab cuam, uas yog nruab nrab ntawm lub kaw lus". Cov tshuaj muaj xws limos lwj antler,Panax notoginseng,Asmeskas ginseng,Cistanche deserticola, saffron, Rhizoma Coptidis, qhiav, pob txha loj, pob txha me, tangerine tev thiab Rhizoma Cynoglossi. Tom qab ntau tshaj 30 xyoo ntawm daim ntawv thov kev kho mob, cov tshuaj no tau siv los kho kaum tawm txhiab tus neeg mob SNOFH uas muaj txiaj ntsig zoo. Cov kev tshawb fawb soj ntsuam tau lees paub tias tag nrho cov txiaj ntsig zoo ntawm kev kho Gujiansan yog 93% [4].

Kab lus no tham txog cov txheej txheem ntawm kev txiav txim ntawm Gujiansan thiab nws cov khoom xyaw nquag hauv kev tswj hwm macrophages los tiv thaiv thiab kho SNOFH thiab muab kev txhawb nqa theoretical rau kev kho mob ntawm lub raum-tonifying thiab ntshav-activates cov tshuaj thiab lwm yam kev npaj los tiv thaiv thiab kho SNOFH.

1 Pathological mechanism ntawm steroid-induced femoral taub hau necrosis

Tam sim no, Fiat staging txoj kev yog feem ntau siv kho mob los faib femoral taub hau necrosis rau tsib theem. Theem 1 femoral taub hau necrosis tsis muaj cov tsos mob thiab cov tsos mob, thaum theem 2 yog asymptomatic lossis tsuas muaj cov tsos mob me me thiab tsis muaj kev txwv tseem ceeb. Theem 3 femoral taub hau necrosis tshwm sim nrog mob plab, mob loj heev, thiab kev sib hloov sab hauv.

Txwv tsis pub, muaj zog sab hauv kev sib hloov ua rau mob hnyav. Theem 4 femoral lub taub hau necrosis tshwm sim nrog mob me me mus rau qhov mob hnyav, claudication hnyav, thiab tsis tshua muaj kev txwv ntawm kev sib koom ua ke ntawm synovial. Kauj Ruam 5 femoral taub hau necrosis nthuav tawm qhov mob nruab nrab mus rau qhov mob hnyav, claudication hnyav, tsis tshua muaj kev sib koom ua ke ntawm synovial, thiab synovial sib koom ua ke deformity. Tam sim no, lub voj voog kev kawm ntseeg tias tiam ntawm SNOFH yog tshwm sim los ntawm ntau yam. Muaj ntau txoj kev xav, xws li txoj kev xav ntawm kev txo qis osteogenic peev xwm ntawm cov pob txha pob txha mesenchymal qia hlwb (BMSCs), cov ntshav tsis muaj peev xwm, kev mob, thiab apoptosis. Txoj kev xav, Tsis yog-coding RNA, thiab Gene Polymorphism Theory

Ntawm lwm yam[1]. Tom qab femoral lub taub hau necrosis, necrotic hlwb tso tawm ntau cov chemokines thiab cytokines, cuam tshuam lub cev tsis muaj zog, thiab thaum kawg ua rau lub cev tsis muaj zog ntawm lub taub hau femoral. Macrophages ua lub luag haujlwm tseem ceeb hauv kev txhawb nqa thiab txo qis qhov mob. Nyob rau tib lub sijhawm, macrophages tseem ceeb hauv kev tswj hwm qhov sib npaug ntawm OB thiab OC [5], uas qhia tau tias macrophages tseem ceeb hauv qhov tshwm sim thiab kev loj hlob ntawm steroid-induced femoral taub hau necrosis.

Hauv kev sim tsiaj txhu ntsig txog SNOFH, glucocorticoids ntxiv rau lipopolysaccharide (LPS) feem ntau siv los ntxias SNOFH necrosis hauv cov qauv tsiaj. Thaum LPS ua ke nrog cov tshuaj hormones, nws yooj yim rau induce femoral taub hau necrosis hauv cov tsiaj [6]. Raws li ib qho endotoxin, LPS nws tus kheej yog ib qho ntawm cov inducing yam ntawm SNOFH. LPS tuaj yeem qhib cov macrophages los ntawm lub xov tooj ntawm tes teeb liab transduction system nyob rau hauv lub cev, thiab synthesize thiab tso tawm ntau yam cytokines thiab inflammatory mediators, yog li cuam tshuam rau lub cev tsis muaj zog thiab ua rau cov kab mob vascular. kev puas tsuaj. Thaum LPS nkag mus rau hauv lub cev, lipopolysaccharide-binding protein LBP (lipopolysaccharide-binding protein) tuaj yeem paub LPS. LBP ua ke nrog LPS monomers thiab thauj mus rau saum npoo ntawm myeloid-derived hlwb, qhov uas nws khi rau LRR structural protein CD14 ntawm qhov chaw ntawm lub hlwb. , tsim LPS-LBP-CD14 triplet complex.

Lub triplet yog tom qab ntawd thauj mus rau qhov nyuaj ntawm Tus Xov Tooj Zoo li receptor 4 (TLR4) thiab myeloid sib txawv antigen (MD2). Lub triplet complex khi rau TLR4 nrog kev pab los ntawm MD-2, qhib TLR4, thiab dimers nws [7]. Tom qab TLR4 tau qhib, nws xa cov teeb liab mus rau hauv cov hlwb, yog li ua kom muaj kev cuam tshuam hauv lub cev. Tom qab lub teeb liab xa mus rau hauv lub cell, lub adapter molecule myeloid txawv qhov txawv (MyD88) yog qhib, thiab IL1R-related protein kinase (IRAK) sib sau ua ke rau hauv lub receptor complex los ntawm MyD88 thiab MyD88 adapter protein analogs, phosphorylating thiab activating IRAK.

IRAK tom qab ntawd dissociates los ntawm qhov nyuaj thiab xa cov teeb liab mus rau qog necrosis factor receptor-associated factor 6 (TRAF6), ua rau nws ua haujlwm. Activated TRAF6 ua cov teeb liab hloov los ntawm activating nuclear factor-κB-inducing kinase (NIK) thiab transforming loj hlob yam -activated kinase (TAK1), thiab thaum kawg activates tus coj nuclear factor kappa-B (NF-κB) thiab filament proteins. Ob txoj hauv kev muaj feem cuam tshuam yog mitogen-activated protein kinase (MAPK). Los ntawm ob txoj hauv kev no, nws kawg ua rau kev tso tawm ntawm IL-1 , IL-1, IL-6, TNF- , NO, thiab lwm yam, tsim ib qhoinflammatory teb[8], yog li ua kom nrawm nrawm ntawm SNOFH. Saib daim duab 1.

Lub polarization ntawm M2 macrophages feem ntau yog tshwm sim los ntawm IL-4 thiab IL-13 los ntawm IL4R ua kom phosphorylation ntawm STAT6 (Signal transducer thiab activator ntawm transcription 6, STAT6) [12]. M2 macrophages tuaj yeem muab faib ua peb hom subtypes: M2a, M2b, thiab M2c, thiab peb subtypes muaj cov haujlwm sib txawv. M2a raug ntxias los ntawm IL-4 lossis IL-13 thiab tuaj yeem txhawb kev loj hlob ntawm tes thiab kho cov ntaub so ntswg. M2c, piv txwv li, inactivated macrophages, yog induced los ntawm cov tshuaj hormones, IL-10 los yog TGF-, thiab plays lub luag hauj lwm nyob rau hauv lub cev tiv thaiv kab mob thiab o inhibition. M2b yog induced los ntawm lub cev tiv thaiv complexes thiab LPS/IL{19}} stimulation, uas yuav ua rau kom IL-10 thiab txo IL{21}} secretion, thiab ua lub luag hauj lwm nyob rau hauv inhibiting theem ntawm o nyob rau hauv lub mob theem. kev kho mob [19] IL-10 tuaj yeem tiv thaiv cov kev mob tshwm sim ntawm lwm cov cytokines xws li TNF- , IL-1, thiab lwm yam, yog li ua lub luag haujlwm hauv kev tswj kev mob. Txij li TNF- , IL-1, thiab lwm yam tuaj yeem qhib TLR4 thiab cov teeb liab qis p38/MAPK txoj hauv kev ntawm TLR4. Raws li ib qho ntawm cov ceg tseem ceeb ntawm txoj kev MAPK, txoj kev p38 / MAPK yog ze ze rau kev mob thiab cell apoptosis.

Thaum qhov kev qhia ntawm p38 / MAPK signaling pathway yog inhibited, theem qhia ntawm OC kuj raug txo qis [20], yog li ua lub luag haujlwm hauv kev tswj cov pob txha homeostasis thiab pob txha sib npaug hauv SNOFH. Hauv SNOFH, thaum qib IL-10 nce, nws tuaj yeem cuam tshuam cov lus teb inflammatory thiab txo qhov mob pob qij txha thiabraug mob los ntawm SNOFH [21]. Yog li ntawd, IL-10 secreted los ntawm macrophages tuaj yeem tsim cov lus teb los tiv thaiv phosphorylation ntawm p38 / MAPK [22], ncua qhov tshwm sim thiab kev loj hlob ntawm SNOFH. Qhov sib npaug dynamic ntawm proinflammatory cytokines TNF- thiab IL1 thiab anti-inflammatory cytokines IL-2, IL-4, thiab IL-10 yog ze ze rau theem ntawm o. Qhov tsis txaus ntawm cov qib ntawm ntau yam proinflammatory cytokines tuaj yeem ua rau muaj qhov tshwm sim ntawm cov kab mob o. Kev faib tawm ntawm M1 thiab M2 macrophages hauv o tuaj yeem cuam tshuam qhov sib npaug ntawm cov tshuaj tiv thaiv thiab tiv thaiv kab mob thiab cuam tshuam rau qhov tshwm sim thiab kev loj hlob ntawm o.

3 Tsoos suav tshuaj thiab steroid-induced femoral taub hau necrosis

Tsis muaj ntaub ntawv teev npe kab mob ntawm SNOFH hauv cov tshuaj suav tshuaj. Nws feem ntau yog kho li tuag tes tuag taw. "Suwen·Changcaijie Lun" hais tias: "Tus kab mob no nyob rau hauv cov pob txha. Yog cov pob txha hnyav thiab nqa tsis tau, cov pob txha mob thiab mob khaub thuas, nws hu ua pob txha tuag tes tuag taw." "Suwen·Antiology": "Yog lub raum qi kub, lub duav thiab txha nraub qaum yuav tsis nqa, cov pob txha yuav qhuav thiab pob txha yuav txo, ua rau cov pob txha flaccidity." "tus ntsuj plig

"Shu Jie Zhen Xie No. 75": "Kev tsis txaus siab phem kuj yog txias hauv lub cev, txias thiab cua sov sib tw, yog tias nws kav ntev, nws yuav nyob hauv. Cov pob txha yuav mob thiab lub cev nqaij daim tawv yuav wither Yog hais tias lub tshav kub overcomes lub txias, ces Rotten nqaij thiab sloughed cov nqaij ntshiv tig mus rau hauv cov kua qaub, thiab sab hauv cov pob txha yuav ua rau pob txha yaig. Pob txha tuag tes tuag taw, pob txha tsis ua hauj lwm, thiab pob txha yaig yuav tsum yog cov npe kab mob sib txawv ntawm cov theem sib txawv hauv kev loj hlob ntawm femoral taub hau necrosis, nrog rau cov kev hloov pauv pathological thiab txawv cov tsos mob tshwm sim. Ntawd yog, nyob rau theem pib, qi blockage thiab cov hlab ntsha occlusion yog cov txheej txheem pathogenesis, uas yog hu ua pob txha tuag tes tuag taw. Nyob rau hauv lub lig theem, muaj vau thiab tsis xws luag ntawm lub taub hau femoral, uas yog hu ua pob txha erosion. Nyob rau theem pib thiab theem kawg, qhov khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob. Ntawd yog, theem pib yog pob txha tuag tes tuag taw, thiab thaum ntxov yog mob. Cov theem nruab nrab yog cov pob txha tsis muaj zog, uas yog tshwm sim los ntawm kev mob ntxiv thiab pib txo cov pob txha pob txha. Cov theem tom ntej yog pob txha erosion, uas yog tus cwj pwm los ntawm cov leeg pob txha thiab pob txha puas. Hauv SNOFH, vim yog siv cov tshuaj hormones mus ntev, cov meridians raug thaiv, Qi thiab ntshav tsis txaus, cov hlab ntsha hauv hiav txwv yog khoob, cov pob txha tuag thiab cov pob txha qhuav. Nyob rau tib lub sijhawm, kev siv cov tshuaj hormones ntev tuaj yeem ua rau lub siab thiab lub raum puas tsuaj, thiab lub hauv paus tseem ceeb raug puas tsuaj.

Hnub tom qab tag kis, nws yuav ua rau Qi tsis txaus nyob rau hauv tus po thiab ob lub raum, Qi yog tus thawj coj ntawm cov ntshav, thiab ntshav yog leej niam ntawm Qi, nws thiaj li ua rau ntshav stasis. Yog li ntawd, nws cov pathogenesis feem ntau yog nyob ntawm lub raum tsis muaj zog thiab ntshav stasis raws li cov tsos mob hauv qab. Clinically, nws muab faib ua hom kab mob xws li daim siab thiab lub raum tsis muaj peev xwm, qi stagnation thiab ntshav stasis. Cov tshuaj suav tshuaj suav tshuaj uas ua kom cov ntshav ncig thiab tshem tawm cov ntshav stasis tuaj yeem txhim kho microcirculation, tswj cov ntshav fluidity thiab viscosity, nce vascular ntshav ntim, txhim kho lub xeev ischemic ntawm SNOFH, thiab txhawb kev kho cov cheeb tsam osteonecrosis [23]. Kev kho SNOFH nrog cov txheej txheem ntawm kev txhawb nqa lub raum thiab ua kom sov yang tuaj yeem txhawb nqa angiogenesis, txhim kho hauv zos microcirculation ntawm lub taub hau femoral, txhawb cov pob txha hyperplasia, thiab kho cov pob txha necrotic hauv SNOFH [24]. Yog li ntawd, hauv kev kho mob tiag tiag ntawm SNOFH, cov tshuaj suav tshuaj feem ntau siv lub raum-tonifying thiab txoj kev kho tseem ceeb yog txhawm rau txhawm rau txhawm rau thiab ua kom cov ntshav ncig.